[Uroinfections and the possibilities of therapy with levofloxacin]. / Uroinfektsii i vuzmozhnosti za terapevtichno povliiavane s levofloxacin.

UNLABELLED: The common occurrence, of inflammatory diseases in the urinary tract and the genitals in men, is quite a reason for identification of the agents and looking for some new chances of therapeutic treatment. MATERIALS AND METHODS: For a period of two years (2002-2003) we accomplished 4810 microbiological tests of urine and prostate secretion on patients with uroinfections. The cultures are completed on standard nutrition medium, as the biochemical identification of the strains is accomplished by the systems mini API and "bio Merieux" BBL Crystal, "Becton Dickinson". Meanwhile for a period of one year, 113 patients with different uroinfections are treated and studied. In 16 (14.1%) Levofloxacin (Tavanic-R) is applied i.v. 500mg/daily as in the rest cases 97 (85.9%) Tavanic are applied per oral in different therapeutic doses. RESULTS AND DISCUSSIONS: The most common agent in our study was the E. Coli, as for the year 2003 we read an increase of the infections caused by E.Coli with 3.4% comparing to the previous one (38.5% to 35.1%). The differentiation of patients treated with Levofloxacin in groups is completed as follows: with acute uncomplicated cystitis--pyelonephritis after ESWL--15.9%; with postoperative uroinfections--20.3%; with chronic post-tuberculosis pyelonephritis--4.4%; and with inflammatory diseases of the male genitals--37.2%.

[The characteristics of parenteral feeding in patients with kidney failure]. / Niakoi osobenosti na parenteralnoto khranene pri bolni s bubrechna nedostatuchnost.

The peculiarities of parenteral nutrition (PN) in patients with renal insufficiency are related first and foremost to the nature of acute renal failure (ARF). The classification of the latter employed shows that it is a matter of a secondary condition, readily responsive to a number of risk factors. To make the diagnosis numerous laboratory examinations, indicators and tests, and the correlations between them are evaluated. Apart from characterizing the kidney function, they make part of the modern basis underlying the differential diagnosis and therapeutic approach. The author's views and experience had with PN in ARF patients undergoing urological surgery are outlined. The basic nutritional problem faced is linked to the patients nitrogen balance and protein food. Protein metabolism and the loss of proteins in the course of dialysis lend themselves to inhibition and compensation by infusions of amino acids and L-histidine at daily dose 0.2-0.6 g/kg body mass. The amino acid mixtures obtained on the KE principle (potato-egg protein) are preferable since they are readily transformed and contain antiammonemic semi-essential amino acids. During chronic dialysis, the need of amino acids augments to 0.8-1.5 g/kg daily. Water intake is limited within the frames of diuresis and perspiration. Calorie requirements vary in the range 25-40 kcal/kg average, and are met by nonprotein calories.

[The use of spinal analgesia in urology]. / Prilozhenie na spinalnata analgeziia v urologiiata.

The past few years are marked by a renewed interest in regional analgesia application in urological practice. The opinion is set forth that this is attributable to the new technique for spinal analgesia suggested, as well as to the influence exerted by the improved endoscopic electroresection technique. To assay spinal analgesia performed by the new technology, the clinical course of spinal analgesia, level of block, expenditure of analgetics, blood loss and changes in hemodynamics are studies in a series of 202 patients, operated in the Clinical Center of Urology. As shown by the results, the block occurs promptly and last for three hours against the background of stable hemodynamics and blood loss reduction. There are no changes in gas exchange and acid-base balance, nor complaints of post-puncture headache. Proceeding from the aforementioned findings, vindication of the spinal analgesia method in urology is proposed.

[The use of atracurium besylate (Tracrium) in patients undergoing kidney transplantation]. / Prilozhenie na atrakurium bezilat (Tracrium) pri bolni s bubrechna transplantatsiia.

According to literature data Atracurium besylate is a nondepolarizing muscle relaxant akin to the "ideal", insofar as it is governed by the "dose-relaxation time" principle. To secure normal clinical effect, doses in the range 0.4-0.5 mg/kg body mass are recommended, with the maximal manifestation of neuromuscular block occurring within 4.6-7.7 min, and lasting for 35.1 to 39.2 minutes. Maintenance dose: 0.05-0.1 mg/kg body mass. Special emphasis is laid on the fact that at normal temperature and pH the dose/relaxation time ratio is strictly fixed which in turn renders relaxation readily controllable. For the purpose a special table is submitted by the producers (Wellcome Company). As it is well known Atracurium splitting runs a course by the so-called Hoffmann reaction, requiring normal pH and temperature. Atracurium is administered to ten chronic renal failure patients in the course of kidney transplantation, abiding to all requirements and doses recommended by the company. A significant muscle relaxation with virtually twice as long duration (35-101 min) is noted, attributable to the presence of metabolic acidosis ("0.605), interfering with the normal course of the Hoffmann reaction for Atracurium disintegration. In the genesis of the phenomena observed any central mechanisms, e.g. hyperventilation, overdosage of the anesthetic, hypothermia and the like, are ruled out. In patients with acidosis it is advised to handle the muscle relaxant with greater caution.

[Propofol in combination with etomidate for anesthesia induction]. / Propofol v kombinatsiia s etomidat za uvod v anesteziia.

Assessment of the joint effect of propofol (Diprivan) and etomidat on hemodynamics and side effects is carried out in a series of 60 patients with ASA I--IV, divided up into two groups of thirty cases each. A single dose of 2.2 mg/kg(-1) propofol brings about safe anesthesia induction. In the event of anesthesia induction being preceded by fentanyl and lormetasepame injections, the propofol dose is reduced to 1.8 mg/kg(-1). The hemodynamics, against the background of an insignificant effect on the patient's post-sedation AP, shows an increase by 10-12 mm Hg, and throughout the anesthesia it remains higher, as compared to that in patients given etomidat. Analysis of the side effects shows isolated cases of flush, fasciculations and the like, prevailing in etomidat cases. Complaints of pain at venipuncture site after propofol are very few. In conclusion, propofol and etomidat account for favourable conditions of anesthesia induction, as well as for short-lasting anesthesia.

[Combined spinal and epidural analgesia in urology]. / Kombinirana spinalna i epiduralna analgeziia v urologiiata.

Combined spinal and epidural analgesia is a new concept in the field of regional anesthesia. It combines the positive qualities of spinal and epidural analgesia, and is performed by the "needle-in-needle" technique, described in the paper. This type of analgesia is practically implemented in the Clinical Center of Urology over the past few months, and shows encouraging results. This is a report on clinical experience had with 10 combined analgesia procedures, running a course free of any complications against the background of stable hemodynamics and respiration of the patients. The block induced is with 4-hour duration, and lends itself to prolongation through an epidural catheter. This renders the method variable and suited for postoperative analgesia too. The Espokan set technical devices used make puncture of the spinal-epidural space readily practicable.

[Anesthesia problems in patients with an infravesical obstruction]. / Problemi na obezboliavaneto pri bolni s infravezikalna obstruktsiia.

The past few years mark an ever increasing interest in intravesical obstructions in urological practice. After clarifying issues relating to the role and type of the underlying disease leading to intravesical obstruction, 173 patients with such a condition, subjected to analgesia of varying type, are analyzed under the aspect of anesthesiology. In 98 cases (56.65 percent) the underlying cause of obstruction is adenoma of the prostate gland, in 60 men and 9 women (39.88 percent)-carcinoma of the bladder, and in eight patients (3.47 percent)-sclerosis of the prostate gland. Preparation of the patients for anesthesia and operation is greatly interfered with by the concomitant polymorbidity, insofar as 83.5 percent of the contingent are older than 60 years of age. Analgesia is secured by endotracheal anesthesia (96 cases), epidural analgesia (64) and spinal-epidural analgesia (13). A comprehensive analysis based on the type of anesthesia and condition of the patient during operation is done, leading to the inference that all three methods are individually indicated.

[Plasma concentrations of 2% lidocaine during epidural analgesia in urology]. / Prouchvane na plazmenite kontsentratsii na lidokain 2% pri epiduralna analgeziia v urologiiata.

The plasma levels of 2 per cent lidocain solution, administered in a mean dose 291.6 mg for epidural analgesia in 24 urologic patients, subjected to transurethral resection. Peak lidocain concentration occurred on the 20 minute and was 2.73 +/- 1.25 mg/l. Positive correlation was found between the administered analgetic dose and the plasma concentration and inverse correlation between age and injected dose. The plasma concentration fall during the studied intervals showed positive correlation with the injected dose and the plasma level being reached; there was inverse correlation between patients age and the fall in plasma lidocain levels. Plasma lidocain levels were for the first time estimated by use of highly effective fluid chromatography--HPLC.